Tobramycin-induced hearing loss in a patient with end-stage renal disease

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Abstract
A 60-year-old female undergoing chronic hemodialysis for end-stage renal disease was evaluated audiologically for the frequencies 0.25, 0.5, 1, 2, 3, 4, 6, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, and 20 kHz over a 7-week period during and after a 4-week course of tobramycin used for control of diverticulitis. Blood levels of the medication were monitored serially and pre- and post-hemodialysis. BAR audiometrics were administered periodically over the 7-week period. Despite conservative medical management where blood levels of medication were allowed to peak at 7 mcg/ml concentration and trough at 2 mcg/ml, the patient demonstrated progressive hearing loss which commenced in the extended high tones and progressively affected lower tone acuity. By the completion of the 7-week period, 6 and 8 kHz were just beginning to show decrease in hearing function while lower primary speech frequencies remained unaffected. BAR data demonstrated no overt changes in wave latencies. Other BAR findings and blood studies were explored with respect to hearing loss findings.

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